Study On The Correlation Between The Levels Of Cardiac Troponin I,myoglobin And Creatine Kinase-MB In Cord Blood And Hypoxic Ischemic Encephalopathy In Neonate

Objective To investigate the changes of cardiact troponin I(cTnI),myoglobin(Mb)and creatine kinase-MB(CK-MB)in cord blood of neonatal hypoxic ischemic encephalopathy(HIE),and to explore their clinical value in HIE.Methods During January to December of 2016,sixty full term infants with high risk factors of perinatal asphyxia and HIE were selected as study group from the obstetrical department of Jinxiang People’s Hospital.Meantime,20 neonates who hospitalized without any high risk factors were selected as the control group.After clinical observation,54 cases who met the diagnostic criteria for HIE,were set as HIE group(10 cases of mild,36 cases of moderate,8 cases of severe).Furthermore,6 cases without HIE were set as non-HIE group.The levels of cord blood cTnI,Mb were detected by chemiluminescence method,and the CK-MB level was detected by Immunosuppression method.The clinical value of different indexes in predicting HIE and myocardial injury was analyzed.Results: There were no obvious differences between the sex,gestational age,weight,body length and the delivery mode of the two groups(P>0.05).Incidence of high risk factors of perinatal asphyxia was a linear rising trend from the control group to the sever HIE group.Incidence of cardiovascular system,electrocardiogram,and echocardiographic abnormalities in HIE group was significantly higher than that in the non-HIE group and the control group(P<0.05).The levels of cTnI and Mb in the moderate and the severe HIE group were significantly higher than the mild group,the non-HIE group and the control group(P<0.05),but no significate differences were observed between the mild group,the non-HIE group and the control group.The levels of CK-MB in the moderate and the severe HIE group were higher than of the mild group,the non-HIE group and the control group(P<0.05),and the mild group were higher than that of the non-HIE group and the control group(P<0.05).With correlation analysis,positive correlations were found between the levels of cTnI,Mb,CK-MB and the severity of HIE(the correlation coefficient was all >0 and P<0.05).The areas under the ROC curve(AUC) of cTnI,Mb and CK-MB in the diagnostic for HIE were 0.896、0.932、0.925.The cutoff values were 0.0157ng/ml,96.53 ng/ml,43.0U/L respectively.The AUC between cTnI,Mb and CK-MB had no statistical significance(P>0.05)by comparing in pairs,but there were statistical significances between the comparison of the combined diagnosis model PRE and cTnI,Mb and CK-MB respectively(P<0.05).The areas under the AUC of cTnI,Mb and CK-MB in the diagnostic for myocardial injury of HIE were 0.767、0.679 、 0.798,and the cutoff values were 0.0159ng/ml,161.47 ng/ml,81.48U/L respectively.The AUC between cTnI,Mb,CK-MB had no statistical significance(P>0.05)by comparing in pairs and same for the significance between cTnI,Mb and PRE.However,there were statistical significance between the comparison of the combined diagnosis model PRE and Mb respectively(P<0.05).Conclusion: The levels of cTnI,Mb and CK-MB in cord blood of HIE neonates had increased in various degrees.Thus the severity of HIE could be early reflected from the levels of them.Early combination measurements of cTnI,Mb and CK-MB in cord blood could predict the incidence of HIE,evaluate the severity,and provide the theoretical basis for early intervention to improve the prognosis.Moreover,early measurements of cTnI,CK-MB in cord blood could predict the incidence of myocardial injury of HIE.